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On Call: Getting Off the Bottle

Q.My 20-month-old can drink from a cup, but when I take his bottle away, he doesn't drink much milk. What should I do?

A. You should get him off the bottle. Children don't need much milk at this age. Before a year, breast milk or formula provides the bulk of their nutrition, even as they start expanding their diet. But after a year, kids should be eating a variety of other foods, and milk becomes less important (in fact, filling up on milk can sometimes prevent them from eating other healthy foods). Sixteen ounces a day is enough.

Nutritionally, milk is important for its protein and calcium, but your child can get calcium from yogurt and cheese, and in vegetables such as broccoli, kale, collards, and mustard greens. He can also get it from sardines, but I haven't met too many kids who are into them. Protein is available in other dairy products, meat, fish, beans, and grains. Milk is fortified with vitamin D, but 16 ounces a day is enough to meet a child's needs, and many other dairy products as well as cereals are supplemented with it.

My youngest child, Natasha, was breastfed exclusively and never made the transition to cow's milk -- she simply doesn't like the taste. Now, at age 3, she'll take a sip here and there, but it adds up to a total of maybe eight ounces a month. So we push other dairy products instead, making sure she gets enough protein, along with calcium-fortified orange juice (which she loves), and daily multivitamins. She's a thoroughly healthy little girl.

Like most people who grew up being told to drink their milk, I certainly thought of it as something positive -- and it is. But as a pediatrician I've seen how too much of a good thing isn't always a good thing. Being on the bottle too long, especially when a child is allowed to sleep with it, can lead to rotting teeth. Also, kids who drink large amounts of milk may end up with anemia or constipation due to the direct effects of excess milk, and also because it can replace iron-rich protein foods, vegetables, and other roughage.

Getting your toddler off the bottle may not be easy -- 20-month-olds are ready to put up a fight for what they want -- but it's the best thing for him. Do it slowly, saving the bottles he most needs for comfort for last (usually these are the bedtime bottles). Then decrease the amount of milk in these bit by bit and substitute lots of snuggling.